Surgical restaging of advanced Hodgkin's disease after first line chemotherapy

Long Term Results after 3 Courses of ABVD plus Subtotal Nodal Radiotherapy in 188 Adult Patients with Stage I, II and IIIA Hodgin Lymphoma

In patients with Hodgkin lymphoma (HL) a continued improvement in outcome with a high cure rate is observed but with an increased treatment-induced late effects. We report the long-term results from 188 (stage I to IIIA) patients treated during the period 1985-94 with 3 courses of ABVD-like chemotherapy and subtotal nodal radiotherapy. 10 year overall survival is of 88% and no secondary leukaemia was observed. The main long term toxicity was cardiac, mainly related to a mediastinal dose of 45 Grays in patients with partial remission. New strategies are aiming to reduce the mediastinal dose at 30 Grays after chemotherapy-induced complete remission.

A prognostic score for advanced Hodgkin's disease. International Prognostic Factors Project on Advanced Hodgkin's Disease

BACKGROUND

Two thirds of patients with advanced Hodgkin's disease are cured with current approaches to treatment. Prediction of the outcome is important to avoid overtreating some patients and to identify others in whom standard treatment is likely to fail.

METHODS

Data were collected from 25 centers and study groups on a total of 5141 patients treated with combination chemotherapy for advanced Hodgkin's disease, with or without radiotherapy. The data included the outcome and 19 demographic and clinical characteristics at diagnosis. The end point was freedom from progression of disease. Complete data were available for 1618 patients; the final Cox model was fitted to these data. Data from an additional 2643 patients were used for partial validation.

RESULTS

The prognostic score was defined as the number of adverse prognostic factors present at diagnosis. Seven factors had similar independent prognostic effects: a serum albumin level of less than 4 g per deciliter, a hemoglobin level of less than 10.5 g per deciliter, male sex, an age of 45 years or older, stage IV disease (according to the Ann Arbor classification), leukocytosis (a white-cell count of at least 15,000 per cubic millimeter), and lymphocytopenia (a lymphocyte count of less than 600 per cubic millimeter, a count that was less than 8 percent of the white-cell count, or both). The score predicted the rate of freedom from progression of disease as follows: 0, or no factors (7 percent of the patients), 84 percent; 1 (22 percent of the patients), 77 percent; 2 (29 percent of the patients), 67 percent; 3 (23 percent of the patients), 60 percent; 4 (12 percent of the patients), 51 percent; and 5 or higher (7 percent of the patients), 42 percent.

CONCLUSIONS

The prognostic score we developed may be useful in designing clinical trials for the treatment of advanced Hodgkin's disease and in making individual therapeutic decisions, but a distinct group of patients at very high risk could not be identified on the basis of routinely documented demographic and clinical characteristics.